March 29, 2017

New Easier-to-Understand Explanation of Benefits (EOB) Introduced

The EOBs got a fresh new look to make them more reader-friendly and easier to understand. We streamlined the design, clarified the claims math and simplified the language to create a straightforward tool to help members better understand their health care finances.

The redesigned full color EOB has a completely new, user-tested layout, and focuses on three major sections:

  1. Total of Claims highlights the major financial information – the amount billed, total benefits approved and the amount the member may owe to the provider – for all claims contained in one EOB.
  2. Service Detail for each claim identifies the services received, the facility or physician, dates of service and the charge – both billed and allowed – and shows what was paid to the provider. For the first time, this new EOB breaks out negotiated provider discounts and deductions from any amounts not covered, visibly showing members the value they receive from their Blue Cross and Blue Shield of Texas benefits coverage.
  3. Summary shows members a clear picture of their deductible, coinsurance, copays and spending accounts.

Another benefit of the new EOB is that simple or shorter claims will fit on one EOB page. Also, only one Appeals Addendum will be produced per set of EOBs (per household). Currently, each claim triggers its own Addendum, so a single mailing can contain multiple addenda. This reduces the amount of paper we produce and improves the customer experience.

The new EOB will also be available in Spanish.

View the new Understanding Your EOBs flier (group members).